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Conteúdo (article):

EXPECTATIVA DE VIDA SAUDÁVEL EM RELAÇÃO A INDICADORES DE SAÚDE BUCAL. CAMPINAS, SP
HEALTHY LIFE EXPECTANCY IN RELATION TO ORAL HEALTH INDICATORS, CAMPINAS, SP
ESPERANZA DE VIDA SALUDABLE EN RELACIÓN CON LOS INDICADORES DE SALUD BUCAL. CAMPINAS, SP

Bruna Kelly Fehlberg: Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP; fehlbergbruna@gmail.com; https://orcid.org/0000-0002-4626-1711.
Ana Paula Belon: Escola de Saúde Pública, Universidade de Alberta, Edmonton, AB, Canadá; ana.belon@ualberta.ca; https://orcid.org/0000-0002-4600-3202.
Marilisa Berti de Azevedo Barros: Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP; marilisa@unicamp.br; https://orcid.org/0000-0003-3974-195X.
Margareth Guimarães Lima: Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP; mglima@unicamp.br; https://orcid.org/0000-0001-6996-0745.

RESUMO
Introdução: o envelhecimento populacional traz desafios à saúde pública, incluindo a saúde bucal, impactada por doenças como a perda dental e o edentulismo. Objetivos: analisar a expectativa de vida sem edentulismo (EVSE) e com saúde bucal autoavaliada como boa (EVAB) na população de Campinas-SP a partir dos 20 anos, considerando diferenças entre sexos. Métodos: foram utilizados dados do Sistema de Informações sobre Mortalidade, Sistema de Informações dos Nascidos Vivos, Censo Demográfico e do ISACamp 2014/2015. O método de Chiang foi aplicado para tábuas de mortalidade e o de Sullivan para estimar EVSE e EVAB. Resultados: aos 20 anos, as mulheres vivem mais sem edentulismo, mas os homens possuem maior proporção de anos livres da condição (87,0% x 81,6%). A EVAB foi superior entre mulheres em todas as idades: aos 20 anos, elas vivem 75,5% do restante da vida com boa saúde bucal, enquanto os homens vivem 73,1%. Aos 80 anos, essa proporção sobe para 85,6% e 74,4%, respectivamente. Conclusão: a EVSE reduz com a idade, sendo proporcionalmente maior nos homens aos 20 anos, enquanto a EVAB é maior em mulheres e idosos, destacando desigualdades ao longo da vida e entre os sexos que exigem intervenções específicas para promover melhorias na saúde bucal da população.
Palavras-chave: Expectativa de Vida Saudável; Saúde Bucal; Perda Dental; Autoavaliação; Inquéritos de Saúde.

ABSTRACT

Introduction: Population aging poses challenges to public health, including oral health, which is affected by conditions such as tooth loss and edentulism. Objectives: To analyze edentulism-free life expectancy (EF-LE) and good self-rated oral health life expectancy (GOH-LE) in the population of the city of Campinas 20 years of age or older, considering differences between the sexes. Methods: Data were obtained from the Mortality Information System, Live Birth Information System, Demographic Census, and ISACamp 2014/2015 survey. Chiang’s method was used to construct mortality tables and Sullivan’s method was applied to estimate EF-LE and GOH-LE. Results: At 20 years of age, women have a longer life expectancy without edentulism, but men have a higher proportion of edentulism-free years (87.0% vs. 81.6%). GOH-LE was higher among women at all ages. At 20, women live 75.5% and men live 73.1% of their remaining years with good oral health. By 80 years of age, these proportions increase to 85.6% and 74.4%, respectively. Conclusion: EF-LE decreases with age and is proportionally higher among men at age 20, whereas GOH-LE is greater among women and older adults. These results demonstrate oral health inequalities throughout life and between the sexes, underscoring the need for targeted interventions to improve the oral health of the population.
Keywords: Healthy Life Expectancy; Oral Health; Tooth Loss; Self-Assessment; Health Surveys

RESUMEN

Introducción: el envejecimiento poblacional plantea desafíos para la salud pública, incluida la salud bucal, afectada por condiciones como la pérdida dental y el edentulismo. Objetivo: analizar la expectativa de vida sin edentulismo (EVSE) y con salud bucal autovalorada como buena (EVAB) en la población de Campinas-SP a partir de los 20 años, considerando diferencias por sexo. Métodos: se utilizaron datos del Sistema de Información sobre Mortalidad, el Sistema de Información de Nacidos Vivos, el Censo Demográfico y la Encuesta de Salud de Campinas (ISACamp 2014/2015). Se aplicó el método de Chiang para la construcción de las tablas de mortalidad y el método de Sullivan para la estimación de EVSE y EVAB. Resultados: a los 20 años, las mujeres viven más tiempo sin edentulismo, pero los hombres presentan una mayor proporción de años libres de esta condición (87,0% vs. 81,6%). La EVAB fue superior en mujeres en todas las edades: a los 20 años, ellas viven el 75,5% del tiempo restante con buena salud bucal, mientras que los hombres viven el 73,1%. A los 80 años, estas proporciones aumentan a 85,6% y 74,4%, respectivamente. Conclusión: la EVSE disminuye con la edad y es proporcionalmente mayor en los hombres a los 20 años, mientras que la EVAB es más alta en mujeres y personas mayores. Estos hallazgos resaltan desigualdades a lo largo de la vida y entre sexos, subrayando la necesidad de intervenciones específicas para mejorar la salud bucal de la población.

Palabras clave: Esperanza de Vida Saludable; Salud bucal; Pérdida de Diente; Autoevaluación; Encuestas Epidemiológicas.

INTRODUCTION
The global population and age structure have changed substantially in recent decades1, and projections for the remainder of the 21st Century show a continuation of global aging2. This trend has also been seen in Brazil, as life expectancy for the Brazilian population went from less than 50 years in the 1950s to 77 years in 2021, and is currently 73.6 years for men and 80.5 years for women, revealing the maintenance of the difference in life expectancy between the sexes over the years3. Although this increase is desired, it poses numerous challenges for public health, especially with regards to ensuring healthy aging4.
Tooth loss tends to increase with age5. Oral diseases are a serious public health concern due to the high prevalence rates and impact on the health of the population6. Tooth loss and edentulism (complete absence of natural teeth) are among the ten leading causes of years lived with disability in some high-income countries due to the aging of the population7. Throughout the world, oral disorders contributed to eight million years lived with disability among individuals 50 to 74 years of age in 20191.
Edentulism affects an estimated 3.3% of the world’s population8, with a higher percentage in the older population9. In Brazil, a large part of individuals 65 to 74 years of age have the complete absence of teeth, corresponding to 36.4% of this portion of the population10. Moreover, the distribution of edentulism is marked by inequalities, with the female sex affected more and also having higher rates of dental caries from an early age6,9,11,12. Adolescent girls are 59% more likely to suffer tooth loss than boys6,9,11,12. The literature also reports that women are more susceptible to overtreatment and iatrogenesis6,9,11,12.
Clinical indicators are used to measure oral problems13, but tend to be limited in terms of the assessment of the interference of oral health status in the lives of individuals13. Thus, the use of subjective indicators of general and oral health has become increasingly important13,14. Self-reported oral health is a multidimensional indicator that combines objective oral health status with social and cultural values15,16 and regards one’s perception of one’s health condition and functional capacity, contributing independently to well-being and satisfaction with life over time13.
With the increasing interest in studying and understanding the quality of the years added to life with the prolongation of life expectancy, studies investigating the role of oral health in healthy aging are essential, as life expectancy can also be influenced by oral diseases17–19. However, few studies have analyzed the relationship between oral health and healthy life expectancy20.
Healthy life expectancy is a synthetic indicator that assists in determining the relationship between oral health and life expectancy. By combining oral health data with life expectancy, it is possible to estimate how many years a person can expect to live with or without oral problems. In Brazil, the few studies that have investigated healthy life expectancy with oral health indicators18,19 focused only on the analysis of the older population. No studies have performed such analyses including younger age groups. Moreover, the studies conducted thus far have investigated life expectancy according to oral health using different indicators. One investigated the negative impact of oral health18 and another used edentulism-free life expectancy as a measure.19 The results of these studies revealed that women tend to live longer with low oral health-related quality of life and have a lower edentulism-free life expectancy. To address these gaps in the scientific literature in Brazil, the aim of the present study was to investigate edentulism-free life expectancy (EF-LE) and good self-rated oral health life expectancy (GOH-LE) in the population of the city of Campinas 20 years of age or older, considering differences between the sexes. The simultaneous investigation of two health indicators (edentulism and self-rated oral health) in the adult population enables a more comprehensive analysis of oral health and generates evidence that can assist in the development of programs and public policies aimed at the prevention and mitigation of oral health problems, thus ensuring a greater number of healthy years of life.
METHODS
This study received approval from the ethics committee of the School of Medical Sciences of the State University of Campinas (certificate number: 75614823.5.0000.5404).
To calculate life expectancy, data from three sources were used: the Mortality Information System21, Live Birth Information System (used to calculate the mortality coefficient and probability of infant death)22, and population projections for the city of Campinas based on data from the 2010 Demographic Census (Brazilian Institute of Geography and Statistics)23. To estimate healthy life expectancy, prevalence data on oral health were obtained from the 3rd Health Survey of the city of Campinas/SP (ISACamp 2014/2015)24.
ISACamp 2014/201524 was conducted with the resident population of the city of Campinas in the state of São Paulo, the inclusion criteria of which were being 10 years of age or older and living in urban areas of the city. Institutionalized individuals did not participate in the survey. The ISACamp 2014/201524 sample was obtained using a probabilistic, two-stage, cluster sampling method. In the first stage, 70 census sectors were drawn in proportion to the number of households. In the second stage, households were randomly selected through a systematic drawing system applied to an updated list of households. The age ranges considered were 10 to 19 years (adolescents), 20 to 59 years (adults), and 60 years or older (older people).
The calculation of the number of individuals for the sample was performed considering an estimated proportion of 50%, which reflects the maximum variability observed in studies of multiple events. A 95% confidence interval and a sampling error of 4 to 5 percentage points were used to ensure accuracy in the results. A design effect of 2 was also applied to account for the complex sampling design, such as stratification or the use of multi-stage sampling, which can increase variability in data. This process resulted in 1,000 adolescents, 1,400 adults, and 1,000 older people. Based on the 2010 census, the probability of the number of individuals in each household by age domain was estimated for the five administrative districts of the city. A total of 3,119, 1,029, and 3,157 households were independently selected for interviews with adolescents, adults, and older people, respectively, to achieve the desired sample size considering non-response rates of 27%, 22%, and 20% for the three age groups, respectively. In each household, all residents in the specific age group for which the household was selected were interviewed. The final sample of the study was composed of 1,023 adolescents, 1,011 adults, and 987 older people, totaling 3,021 participants.
For the present study, only adults (20 to 59 years) and older people (60 years or older) were considered to determine the prevalence of edentulism and self-rated oral health, totaling 1,998 participants. Although included in the general ISACamp sample, adolescents (10 to 19 years of age) were excluded from these analyses due to the low rate of edentulism. Since the age groups were treated as independent sample domains, the exclusion of the adolescent group did not compromise the representativeness or robustness of the estimates obtained for the other age groups.
Data were collected with the aid of a pre-coded questionnaire composed mainly of closed-ended questions organized into 13 sections addressing different topics, including oral health. Face-to-face interviews were conducted by supervised interviewers who had undergone training exercises and the data were collected with the aid of an electronic device (tablet). The study was carried out with the written consent of each participant.
Edentulism was assessed through the answer to the following question: Have you ever lost any teeth (upper or lower)? If so, have you lost one, more than one, or all of your teeth? The four possible response options were “no”, “yes, only one tooth”, “yes, more than one tooth”, and “yes, all teeth”. The total absence of teeth was considered edentulism; only those who answered “yes, all teeth” were in this category.
In addition to edentulism, self-rated oral health was also analyzed. For such, the participants answered the following question: How do you rate your oral health? The response options were “very good”, “good”, “fair”, “poor” and “very poor”. Self-rated oral health was dichotomized as good (answers of “very good” and “good”) or poor (answers of “fair”, “poor” and “very poor”). This form of dichotomization was based on previous studies25,26.
Estimates of the prevalence with respective 95% confidence intervals (CI) of poor self-rated oral health and edentulism were calculated by sex and age group in five-year intervals (20 to 80 years or older). Associations were tested using the chi-square test with the Rao-Scott correction. The significance level was set at 5% (p ≤ 0.05). As lower rates of edentulism are found in younger age groups (20 to 49 years), the rates were grouped for better presentation of the data and categorization by age group was performed at five-year intervals beginning at 50 years of age, considering the higher prevalence of the condition older age groups. Age-specific mortality rates were also estimated at five-year intervals in the population 20 to 80 years and older, using all-cause mortality data from the 2014-2016 period and the 2015 population. Chiang’s method27 was used to construct the abbreviated mortality tables for men and women. With this method, mortality rates were transformed into probabilities of death at the exact age with the formula below and used to obtain life expectancy.

in which:
qx, x+n = probability of death between age x and x+n
mx, x+n = coefficient of death between age x and x+n
n = age group interval
ax, x+n= proportion of years lived by those who died in that age interval.
Healthy life expectancy corresponds to the number of years an individual can expect to live in a healthy state28. Life expectancy without edentulism and life expectancy with good oral health and respective 95% CIs were estimated by Sullivan’s method29, using the self-reported prevalence (ISACamp 2014/2015)24 of these factors (edentulism and poor self-rated oral health) in each age group to determine the average number of years of life that would be lived with and without these health states. Sullivan’s method involves several functions of the mortality table: First, multiply the number of person-years in a specific age group (Lx, x+n, in which Lx, x+n = the total number of years lived by all individuals between age x and x+n) by the proportion of individuals without a certain health condition in the same age group (1- nx, in which nx = proportion of individuals with a certain health condition between age x and x+n):
Lx * (1-x)
The total number of person-years lived without a given health condition from a specific age (Tx) is obtained through the following formula (in which 80+ is the last age group used in our mortality table):


Healthy life expectancy (HLE) at a specific age is given by dividing TX by the number of survivors at the same age.


Both edentulism-free life expectancy and life expectancy with good oral health were calculated by sex and age group. The percentages of years lived without edentulism and with self-assessed good oral health were calculated, using the following formula:



in which:
% HLEx = proportion of years lived with health at age x (i.e., without edentulism/with good oral health)
HLEx = healthy life expectancy at age x (i.e., without edentulism/with good oral health)
LEx = life expectancy at age x
Sullivan’s method was also used to estimate p-values, adopting a 5% significance level.

RESULTS
The rates of edentulism (complete absence of teeth) by sex and age group are displayed in Table 1. The prevalence of edentulism in the total population of the city of Campinas was 9.5%. The proportion was higher among women in the total population. However, no statistically significant differences between the sexes were found in the different age groups. Moreover, the prevalence of edentulism increased with age, with the highest number found among individuals aged 80 years or older (65.9%). No significant differences were found in the prevalence of poor self-rated oral health by sex or age group (Table 2).
The estimates of edentulism-free life expectancy and life expectancy with good self-rated oral health are displayed in Table 3. Younger people have a longer edentulism-free life expectancy. Time lived without edentulism tends to decrease with the increase in age. Beginning at 60 years of age, individuals tend to live less time without edentulism in terms of both absolute and relative frequencies. Life expectancy with good self-rated oral health tends to increase proportionally beginning at 55 years of age and the proportion of years lived with good self-rated oral health was higher among older people, going from 74.4% at 20 years of age to 81.9% at 80 years of age and older. Moreover, when comparing the two indicators, edentulism-free life expectancy from 20 to 39 years of age was higher than life expectancy with good oral health. In contrast, life expectancy with good oral health was longer among individuals 55 years of age and older.
The differences in edentulism-free life expectancy between men and women are displayed in Table 4. At 20 years of age, women tend to have a longer edentulism-free life expectancy in absolute years (borderline statistical significance). However, the proportion of years to be lived without edentulism was higher among men. Proportionally to the years to be lived, men in this age group tend to live 87.0% of the rest of their lives without edentulism, whereas this proportion is 81.6% among women.
Differences between the sexes in life expectancy with self-rated good oral health were significant across all age groups. The number of absolute years lived with good oral health decreased with age in both sexes. Both in absolute years and proportion to the years to be lived, women tend to live longer with good self-rated oral health. The proportion of years to be lived in good oral health increased with age. Women in the age 20-year-old group tend to live 75.5% of the remainder of their lives with good self-rated oral health, whereas this proportion is 73.1% among men of the same age. Among older people, women at 80 years of age tend to live 85.6% of the rest of their lives with good oral health, whereas this proportion is 74.4% among men of the same age. Differences between the sexes in absolute years decreased beginning at 45 years of age, ranging from 5.9 years at age 20 to 1.8 years at age 80 (Table 5).

DISCUSSION
This study investigated edentulism-free life expectancy (EF-LE) and life expectancy with good self-rated oral health (GOH-LE) in the population of the city of Campinas 20 years of age and older. To the best of our knowledge, this is the first study to use the latter indicator as well as investigate possible differences between the sexes for both indicators.
The results revealed a progressive reduction in EF-LE with the advance in age in both absolute and proportional terms, reflecting the accumulation of the burden of oral diseases throughout life. Another finding was that, although women had a longer total life expectancy and more absolute years lived without edentulism, the proportion of years to be lived without complete tooth loss (%EF-LE) was higher among men, which suggests that women live longer, but with a higher burden of tooth loss. Similar results were found among older people in the city of São Paulo19. Moreover, another study conducted in Brazil found that women live longer with lower oral health-related quality of life18. In Japan, Matsuyama et al. (2021)17 found that having fewer teeth was associated with lower healthy and total life expectancy as well as longer life expectancy with disability in both sexes. Yamato et al. (2022)30 reinforced these findings by demonstrating that older adults with 20 or more teeth lived an average of two years longer without disability than those with 0 to 9 teeth.
These data reflect the lasting effects of a dental care model historically centered on extractions and with a low power of resolution6,9. The high prevalence of edentulism among older people is related to the low offer of preventive actions in past decades and the sociocultural notion that tooth loss is a natural part of aging6,9. For a long time, tooth extraction the main and often only treatment option accessible to a large part of this population. This generation lived their childhood and youth without access to a fluoridated water supply and without the widespread use of fluoridated toothpastes, for which national coverage was only expanded beginning in the 1980s6,9.
Despite advances in oral health, edentulism persists as an important public health problem, especially in the context of global population aging31. According to data from the Global Burden of Disease 202131, the prevalence of edentulism varies in different regions of the world, with rates ranging from 1.3% to 78% among individuals 65 years of age and older31. In 2021, around 26.5 million new cases were registered throughout the world31, with high rates in South America31. In Brazil, although the rate of edentulism among older people dropped from 54% in 2010 to 36.4%10 in 2023, the numbers remain high, revealing a persistent situation of vulnerability. Moreover, global data show that women have a higher burden of edentulism beginning at 20 years of age, with higher rates of incidence, prevalence, and years lived with disability (YLD) than men up to 74 years of age. After the age of 80, a more pronounced decline is observed among women, suggesting possible differences in the pattern of progression and impact of edentulism according to sex31.
Edentulism is associated with unfavorable health outcomes, such as a low quality of life, mortality19,32–35, the aggravation of chronic diseases, and cognitive impairment35. However, a large portion of tooth loss is preventable9,12. The implementation of strategies aimed at the prevention and control of oral diseases is needed in all age groups for the preservation of quality of life and general health, especially in view of the aging of the Brazilian population.
Differences between the sexes in EF-LE are also noteworthy. A possible explanation for the higher burden of tooth loss among women is the greater use of dental services, which, depending on the practice, can result in overtreatment and tooth loss9,12,36. High dental costs often make treatment unfeasible, thus favoring extraction12. Moreover, the prevalence of dental caries tends to be higher in the female sex in different contexts and age groups, which may be explained by biological, hormonal, and social factors37. These data underscore the need for measures that promote the reduction of inequalities in oral diseases, especially in relation to tooth loss, and increase tooth retention throughout life, especially in women, contributing to their healthy aging.
Despite the lower EF-LE among women, the results showed that they live longer with good self-rated oral health. To the best of our knowledge, this is the first study to assess healthy life expectancy based on self-rated oral health. Brazilian studies28,38 investigated healthy life expectancy based on self-rated general health have indicated that women tend to live longer with good health. However, evidence from Brazil39, Chile40, and China41 indicates that women live proportionally fewer years in good health, despite their greater longevity. These findings highlight the complexity of the health-survival paradox between the sexes.
The recovery of oral health with the use of dental prostheses can exert a positive impact on self-image and behavior. The reestablishment of chewing function, speech, and dental aesthetics leads to improvements in social aspects and quality of life30,42. A previous study showed that older people with zero to nine teeth who wore dentures lived an average of three years longer without disability compared to those who did not wear dentures30. The difference was one year among those with 10 to 19 teeth. This indicates that the use of prostheses can attenuate the negative impacts of a compromised dentition, especially among the most severely affected individuals30.
The greater use of dental prostheses among women has been attributed to the higher frequency of dental appointments and greater concern for self-care among women6,43. The impact of tooth loss is greater among women than men42. Edentulous women tend to feel less confident and more embarrassed because they believe that edentulism makes them less attractive42. Thus, it is likely that the greater use of dental prostheses among women contributes to a better self-assessment of their oral health.
The present study also demonstrated that, although older people have a lower proportion of years to be lived without edentulism, both older men and women tend to live longer with good self-rated oral health. These data suggest that subjective oral health indicators can capture dimensions of well-being and adaptation that are not revealed by objective clinical measures. Other national and international studies have also found better self-rated oral health among the older people15,44,45. The acceptance of tooth loss as part of the aging process may help explain this perception. A study investigating the impact of oral diseases on quality-adjusted life expectancy (QALE) among adults in the United States showed that tooth loss had less of an effect among older people, whereas the impact of dental caries was greater in this age group32. These findings suggest that older people may adapt better to the absence of teeth over time.
One limitation of the present study was the lack of a clinical examination to diagnose the oral health status of the interviewees. However, the literature reports the high validity of self-perception with regards to the number of one’s teeth46,47. The use of self-reported measures in population-based surveys constitutes a viable, low-cost, far-reaching option13. Surveys that use self-reported oral health data collected through a questionnaire applied by trained interviewers constitute an option with a shorter execution time and without the need for health professionals, which is important for large-scale population-based investigations14. Another limitation regards the scarcity of studies in the literature on healthy life expectancy based on oral health indicators, hindering direct comparisons and the positioning of the findings in broader contexts. Moreover, although Chiang’s and Sullivan’s methods enable the estimation of healthy life expectancy, the present study did not have a longitudinal design. Thus, estimates of edentulism-free life expectancy and life expectancy with good oral health are inferences derived from aggregated prevalence and mortality data and therefore do not reflect individual trajectories, as no follow-up was conducted of cohorts over time. However, one should bear in mind that longitudinal oral health data are not common and multi-state methods for calculating healthy life expectancy that capture transition rates between health states produce similar results48. Therefore, Chiang’s and Sullivan’s methods are solid alternatives to cohort mortality tables and multi-state methods.
For an aging society, public health must focus efforts not only on increasing life expectancy, but also on increasing healthy life expectancy, including that related to oral health, which has important implications for the health and well-being of the population. Thus, our study offers an original contribution by estimating healthy life expectancy based on different oral health indicators, which is an issue that has not previously been explored in the literature. The approach adopted is particularly relevant, as it included all adults and not only older people. Moreover, the literature has demonstrated the relevance of using different indicators to gain a better understanding of the magnitude of differences in health between the sexes and points out that the analysis of healthy life expectancy for this purpose is an important tool28,49.
Belon et al.28 analyzed differences in healthy life expectancy between the sexes and found different results depending on the health indicator studied: older women could expect to live longer and most of the years would be spent with better self-rated health. However, they would live longer years with functional limitations compared to older Brazilian men. Our results add evidence to this discussion and enrich it with data for oral health by demonstrating that, although women had a lower proportion of life without edentulism, this did not prevent them from living longer with good self-rated oral health. Therefore, in addition to preventing tooth loss, it is necessary to promote access to rehabilitation, such as dental prostheses, especially among the most vulnerable groups, to ensure healthier and more equitable aging.

CONCLUSION
Our study on edentulism-free life expectancy (EF-LE) and life expectancy with good self-rated oral health (GOH-LE) in the population of Campinas revealed important differences related to age and sex. EF-LE was higher among young people, with a downward trend in absolute and proportional terms beginning at 60 years of age. In contrast, GOH-LE demonstrated the opposite behavior – an increasing proportion of years lived with good oral health with the advance in age. Differences between the sexes were also found. Although women at 20 years of age have a higher EF-LE in absolute years, men tend to live a larger portion of the rest of their lives without edentulism. With regards to GOH-LE, women had a longer life span with good oral health.
These results highlight oral health inequalities throughout life and between the sexes, underscoring the need for targeted interventions that consider age and gender differences to promote improvements in the oral health of the population. Studies on EF-LE and GOH-LE can guide healthy aging policies, prioritizing oral health through preventive actions, expanding access to dental services, and reducing inequalities. Such measures can favor the maintenance of teeth over the years, reduce disability, and improve quality of life, thus contributing to healthy longevity. The continuous monitoring of these indicators enriches the discussion on health in old age and plays a fundamental role in the planning of sustainable societies in the face of the challenge of population aging.

The dataset of this article is available in the SciELO Data repository in the Science & Collective Health Dataverse through the link: https://doi.org/10.48331/SCIELODATA.IZTHKX

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